MEDICARE: MAYA FAMILY MEDICAL CENTRE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1851566251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYA FAMILY MEDICAL CENTRE INC

Provider Business Mailing Address
First Line	:	4527 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4415
Country	:	US
Telephone Number	:	773-267-6617
Fax Number	:	773-267-0460

Provider Business Practice Location Address
First Line	:	4527 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4415
Country	:	US
Telephone Number	:	773-267-6617
Fax Number	:	773-267-0460

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CHANDRA MOHINI KHURANA
Credential	:	M.D.
Telephone Number	:	773-837-1550

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	03/04/2015

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